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01-04-2013 | Article

EULAR makes recommendations for rheumatoid arthritis imaging

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medwireNews: The European League Against Rheumatism (EULAR) has developed 10 recommendations for the use of imaging of the joints in rheumatoid arthritis, including for diagnosis, detecting inflammation, predicting outcome, and monitoring progress.

"The recommendations were developed by an international group of experts with [a] detailed literature review, and aimed to address clinical questions relevant to current practice," say Philip Conaghan, from the University of Leeds in the UK, and colleagues.

Nevertheless, they state in the Annals of the Rheumatic Diseases: "We acknowledge there is still a large amount of research required to optimise the use of imaging tools in routine clinical practice, in particular which joints should be used for disease assessment and monitoring and consideration of the feasibility, costs and appropriate training required to use ultrasound and MRI [magnetic resonance imaging] in clinical practice."

To develop the recommendations, an expert group of rheumatologists, radiologists, methodologists, and experienced rheumatology practitioners from 13 countries was assembled. After a process of discussion and consensus, they arrived at 13 key questions on the role of imaging in rheumatoid arthritis.

The researchers then carried out a systematic literature search for evidence relevant to each question, which yielded 199 studies that they used to formulate 10 recommendations. The evidence used was categorized according to study design into four levels (I-IV), with level I representing the best-quality evidence, and each recommendation was given a strength using a visual analogue scale.

The recommendations, which include guidelines on the use of conventional radiography, ultrasound, MRI, computed tomography, dual-emission X-ray absorptiometry/digital X-ray radiogrammetry, scintigraphy, and positron emission tomography, focus on a range of areas in the clinical management of rheumatoid arthritis.

These are: making a diagnosis of rheumatoid arthritis; detecting inflammation and damage; predicting outcome in rheumatoid arthritis; predicting response to treatment; monitoring disease progression; determining which joints to assess; and imaging in clinical remission.

The perceived strength of the recommendations ranges from 7.8 to 9.4 on a 10-point scale. However, it is notable that the level of evidence is III or IV for all recommendations.

Owing to a lack of literature, the experts did not make a recommendation on detecting joint space narrowing, although, as they note, it "is important to consider in view of the impact on functional status". Instead, this was included as one of five items in a future research agenda.

By Liam Davenport, medwireNews Reporter